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Update 1990 pp 758-769 | Cite as

Pain and Sedation in the Pediatric Patient: The 1990 Approach to a Very Old Problem

  • D. A. Rosen
  • K. R. Rosen
Conference paper
Part of the Update in Intensive Care and Emergency Medicine book series (UICM, volume 10)

Abstract

The child presenting to the Pediatric Intensive Care Unit (PICU) is experiencing disease symptoms, pain, and anxiety. The physician tends to focus on the disease process often overlooking the pain and anxiety, buth the child cannot overlook them as easily. The young patient‘s anxiety is strongly aroused by the strange surroundings and lack of familiar faces. Pain is immediate and intrusive.

Keywords

Benzyl Alcohol Pediatric Intensive Care Unit Patient Control Analgesia ECMO Circuit Midazolam Infusion 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References

  1. 1.
    McGrath PJ, Unruh A (1987) Pain in children and adolescents. Elsevier Science, AmsterdamGoogle Scholar
  2. 2.
    Mather L, Mackie J (1983) The incidence of postoperative pain in children. Pain 15:271–282PubMedCrossRefGoogle Scholar
  3. 3.
    Beyer JE, DeGood DE, Ashley LC, et al (1983) Patterns of postoperative analgesia use with adults and children following cardiac surgery. Pain 17:71–81PubMedCrossRefGoogle Scholar
  4. 4.
    Schecter NL, Allen DA, Hanson K (1986) Status of pediatric pain control: A comparison of hospital analgesic usage in children and adults. Pediatrics 77:11–15Google Scholar
  5. 5.
    McGrath PJ, Johnson G, Goodman JT, Schillinger J, Dunn J, Chapman J A (1985) CHEOPS: A behavioral scale for rating postoperative pain in children. In: Fields, Dubner, Cervero (eds) Advances in pain research and therapy, 9th edn. Raven Press, New York, pp 395–402Google Scholar
  6. 6.
    Beyer JE (1984) The oucher: A user‘s manual and technical report. University of Virginia Alumni Patent Foundation, CharlottesvilleGoogle Scholar
  7. 7.
    Hannallah RS, Broadman LM, Belman AB, Abramowitz MD, Epstein BS (1987) Comparison of caudal and ilioinguinal/iliohypogastric nerve blocks for control of post-orchidopexy pain in pediatric ambulatory surgery. Anesthesiology 66:832–834PubMedCrossRefGoogle Scholar
  8. 8.
    Anand KJS, Hickey PR (1987) Pain and its effects in the human neonate and fetus. N Engl J Med 317:1321–1329PubMedCrossRefGoogle Scholar
  9. 9.
    Anand KJS, Sippell WG, Aynsley-Green A (1987) Randomised trial of fentanyl anesthesia in preterm babies undergoing surgery. Effects on the stress response. Lancet 1 62–66PubMedCrossRefGoogle Scholar
  10. 10.
    Parfrey NA, Moore W, Hutchins DM J (1984) Is pain crisis a cause of death in sickle cell disease. Clin Pathol 84:209–212Google Scholar
  11. 11.
    Snyder SH (1984) Drug and neurotransmitter receptors in the brain. Science 224:22–31PubMedCrossRefGoogle Scholar
  12. 12.
    Wood PL (1982) Multiple opiate receptors: support for unique mu, delta and Kappa sites. Neuromarmacoloty 21:487–497CrossRefGoogle Scholar
  13. 13.
    Rosen KR, Rosen DA (1989) Caudal epidural morphine for control of pain following open heart surgery in children. Anesthesiology 70:418–421PubMedCrossRefGoogle Scholar
  14. 14.
    Jones SE, Beasley JM, Macfarlane DW, David JM, Hall-Davies G (1984) Intrathecal morphine for postoperative pain relief in children. Br J Anaesth 56:137–140PubMedCrossRefGoogle Scholar
  15. 15.
    Krane EJ (1988) Delayed respiratory depression in a child after caudal epidural morphine. Anesth Analg 67:79–82PubMedCrossRefGoogle Scholar
  16. 16.
    Gaukroger PB, Tomkins DP, Vander Wait JH (1988) Use of patient-controlled analgesia (PCA) in children. J Pediatr Surg 23(12): 1227–1228PubMedCrossRefGoogle Scholar
  17. 17.
    Mcllvaine WB, Know RF, Fennessey PV, Goldstein M (1988) Continuous infusion of bupi-vacaine via intrapleural catheter for analgesia after thoracotomy in children. Anesthesiology 69:261–264CrossRefGoogle Scholar
  18. 18.
    Merriman HM (1981) The techniques used to sedate ventilated patients. A survey of methods used in 34 ICUs in Great Britain. Intensive Care Med 7(5): 217–224PubMedCrossRefGoogle Scholar
  19. 19.
    Bion JF, Ledingham IM (1987) Sedation in intensive care - a postal survey. Intensive Care Med 13(3):215–216PubMedGoogle Scholar
  20. 20.
    Rosen DA, Rosen KR (1990) Benzodiapapine usage in the pediatric intensive care unit. Intens Care Med (in press)Google Scholar
  21. 21.
    Silvasi DL, Rosen DA, Rosen KR (1988) Continuous intravenous midazolam infusion for sedation in the pediatric intensive care unit. Anesth Analg 67:286–288PubMedCrossRefGoogle Scholar
  22. 22.
    Galvin GM, Jelinek GA (1987) Midazolam: an effective intravenous agent for seizure control. Arch Emerg Med 4:169–172PubMedGoogle Scholar
  23. 23.
    Crevoisier C, Ziegler WH, Eckert M, Heizmann P (1983) Relationship between plasma concentration and effect of midazolam after oral and intravenous administration. Br J Clin Pharmacol 16:51–61 SGoogle Scholar
  24. 24.
    Wilton NCT, Leigh J, Rosen DA, Pandit R (1988) Preanesthetic sedation of preschool children using intranasal midazolam. Anesthesiology 69:972–975PubMedCrossRefGoogle Scholar
  25. 25.
    DeJong PC, Verburg MP (1988) Comparison of rectal to intramuscular administration of midazolam and atropine for premedication of children. Acta Anaesthesiol Scand 32(6):485–489CrossRefGoogle Scholar
  26. 26.
    Burnstein S (1988) The uses of midazolam and flumazanil in intensive care resuscitation. 16(suppl) 5100–5106Google Scholar
  27. 27.
    Vinik HR, Bradley EL Jr, Kissin I (1989) Midazolam-alfentanil synergism for anesthetic induction in patients. Anesth Analg 69:231–237CrossRefGoogle Scholar
  28. 28.
    Tverskoy M, Fleyshman G, Ezry J, Bradley EL Jr, Kissin I (1989) Midazolam-morphine sedative interaction in patients. Anesth Analg 68:282–285PubMedCrossRefGoogle Scholar
  29. 29.
    Jardine DS, Rogers K (1989) Relationships of benzyl alcohol to kernicterus, intraventricular hemorrhage, and mortality in preterm infants. Pediatric 83:153–160Google Scholar
  30. 30.
    Persson MP, Nilsson A, Hartvig P (1988) Relation of sedation and amnesia to plasma concentration of midazolam in surgical patients. Clin Pharmacol Ther 43: 324–331PubMedCrossRefGoogle Scholar
  31. 31.
    Lloyd-Thomas AR, Booker PD (1986) Infusion of midazolam in paediatric patients after cardiac surgery. Br J Anaesth 58:1109–1115PubMedCrossRefGoogle Scholar
  32. 32.
    Oldenhof H, deJong M, Steehock A, Janknegt R (1988) Clinical pharmacokinetics of midazolam in intensive care patients, a wide interpatient variability. Clin Pharmacol Ther 43:3, 263–269PubMedCrossRefGoogle Scholar
  33. 33.
    Mackinnon GL, Parker WA (1982) Benzodiazepine withdrawal syndrome: A literature review and evaluation. Am J Drug Alcohol Abuse 9:19PubMedCrossRefGoogle Scholar
  34. 34.
    Committee on Safety of Medicines (1988) Benzodiazepines, dependence and withdrawal syndrome. Curr Probl:21Google Scholar
  35. 35.
    Sury MRJ, Russel GN, Thornington R, Vivori E (1989) Acute benzodiazepine withdrawal after midazolam infusions in children. Crit Care Med 17:301–302PubMedCrossRefGoogle Scholar
  36. 36.
    Ziegler WH, Schalch E, Leishman B, Eckert M (1983) Comparison of the effects of intravenously administered midazolam, triazolam and their hydoxymetabolites. Br J Clin Pharmacol 16:63–69SGoogle Scholar
  37. 37.
    Silvasi DL, Rosen D, Rosen KR (1989) Absorption of midazolam by the SciMed membrane oxygenator (Abstract). Anesth Analg 68:S 261Google Scholar
  38. 38.
    Rosen D, Rosen K, Davidson B, Broadman L (1988) Fentanyl uptake by the SciMed membrane oxygenator. J Cardiothor Anesth 619–626Google Scholar
  39. 39.
    Leong P, Rosen D, Rosen K (1990) Uptake of lorazepam by SciMed oxygenator membrane. Anesth Analg 70:Suppl (in press)Google Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 1990

Authors and Affiliations

  • D. A. Rosen
  • K. R. Rosen

There are no affiliations available

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